Date: Tue, 27 Oct 1998 14:18:09 -0800
Reply-To: "William W. Viergever" <wwvierg@IBM.NET>
Sender: "SAS(r) Discussion" <SAS-L@UGA.CC.UGA.EDU>
From: "William W. Viergever" <wwvierg@IBM.NET>
Subject: Re: Resolving Comprehensive and Component codes (CPT)
In-Reply-To: <199810271628.QAA08988@smtp-relay.power.net.uk>
Content-Type: text/plain; charset="us-ascii"
Good point John.
However, I suspect they have a date of service variable (DOS, FROM) in which case they could qualify it as those who ordered the Happy Meal _and_ the extra fries <g> on the same day (or proximate days) are pigs and those that ordered them on different days are not pigs.
From a third party payment perspective, the providers are not allowed to be pigs! <vbg>
(Most packages that I've seen in the realm of fraud/abuse or unbundling detection packages also make an attempt to monitor history/volume of the CPT4's/HCPCs as well. Before you know it you've got a new UR and/or Practice Guidlines/Profiles product).
Later
At 04:27 PM 10/27/98 +0000, John Whittington wrote:
>At 11:16 27/10/98 -0500, Gary M. McQuown wrote:
>
>[large snip]
>
>>Another perspective is that Alpha contains A_H; a list of all discounted
>>combinations (happy meals, value meals, and lunch specials), and A_O; a
>>corresponding list of items that make up the combinations (drinks, fries,
>>burgers, etc.). Data set Beta contains a list of purchases by each
>>individual. Find anyone who bought a Happy Meal and was charge twice for
>>the fries (once in the Happy Meal charge and then again in the itemized
>>charge for the fries) .
>
>Gary, without (yet) addressing the issue of programming, at least with the
>'perspective' you offer above, it would seem that there might be an
>underlying problem ... how can you distinguish between the person you
>describe, who was incorrectly 'double-charged' for fries, and someone who
>ordered a Happy Meal _plus_ an extra order of fries, and was correctly
>charged for both? Does such a potential also exist with the 'real problem'?
>
>Regards
>
>John
>
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